Finger rectal examination

Finger research is an obligatory moment of proctologic examination, the diagnostic value of which is difficult to overestimate. Emphasizing the importance of this method, VM Mysh wrote: "The area of diagnostic capabilities of sigmoidoscopy is exhausted by diseases of the intestine itself, while finger research through the rectum is an extremely valuable and widely available method of investigation of both the intestine and a number of adjacent organs." Of particular importance is the method of finger research in the diagnosis of colorectal cancer.

It is known that the diagnosis of colorectal cancer can be made on the basis of finger research alone in 80-85% of cases, and it is possible to determine the exophytic or endophytic growth of the tumor, the degree of its displacement, the distance from the anus, and narrowing of the lumen of the intestine. In addition to examination of the rectum, the condition of neighboring organs is determined (the prostate gland in men, the cervix and the posterior surface of the uterus in women).

The results of digital rectal examination (PRI) are the basis for drawing up a plan for further examination of a patient with suspected chronic prostatitis. The method is valuable not only for its simplicity and general availability, but also for its high informativeness.

There are 3 provisions in which the rectal examination of the prostate is performed:

1. on the right side with the knees brought to the stomach. This position is most convenient for examining elderly and weakened patients;
2. traditional, knee-elbow position;
3. in the position of the subject standing with an anteriorly bent trunk.

When palpating the prostate, the index finger of the right hand (with a rubber glove or fingertip) is smeared with petroleum jelly and injected lightly into the anus, where the lower pole of the prostate glands at a distance of 4 -5 cm. Carefully slip your finger along the surface of the prostate, evaluate its contours, dimensions, shape, consistency, sensitivity, the condition of the interlobar groove.

The unchanged prostate is compared in size and shape with a small chestnut, facing the rounded apex downwards. Usually, the finger freely reaches the upper border of the unimproved prostate. Normally, palpation distinguishes between two parts of the prostate, between which a distinctive interlobar groove is prominent. The average size of each share is 14 x 20 mm, their surface is smooth, the consistency is elastic, the boundaries are clear. The mucous membrane of the rectum over the prostate glands easily shifts.

Own clinical experience and the opinion of numerous authors suggest that there is a relationship between the clinical stage of chronic prostatitis and changes in the prostate that are detected in digital rectal examination.

Stage I is characterized by an increase (sometimes significant) in the size and swelling of the prostate, expressed by its painfulness, uniform dense elastic consistency. The centers of compaction and softening at this stage are not determined. The boundaries of the gland may be fuzzy due to infiltration of the surrounding tissue.

For the II stage of the disease, the normalization of the prostate size, the reduction of its soreness, the unevenness of the consistency (alternation of the compaction and softening regions) are more typical. Sometimes it is possible to probe the stones of the prostate gland, the boundaries of which are more precise at this stage. Due to the pronounced disruption of the structure and function of the smooth-muscular formations, the prostate gland can become flabby, atonic.

At stage III of chronic prostatitis, iron is reduced in size, usually painless; its consistence is dense; the boundaries are clear. The mucous membrane of the rectum above it is moderately mobile. After the massage of the sclerotic gland secret from it is not allocated.

Even in a healthy person, the pressure on the finger is simple accompanied by unpleasant sensations, radiating into the penis. In a patient with chronic prostatitis, soreness in palpation is much greater. The intensity of subjective sensations is very different for different people. All this must be taken into account by the doctor who performs this diagnostic procedure.

Due to the variation in the size, shape and consistency of the prostate, it is necessary to compare these and other features of the left and right lobes for a correct evaluation of the condition, and also the data obtained in the analysis of the secretion of the prostate IF Yunda (1982) described the symptom of the "sickle" crescent atrophy of the prostate. In case of androgen deficiency, the prostate takes the form of a sickle that is open upward, that is, the upper segment of the prostate is flattened and sagging, and the lower segment in the form of a rim, as it were, fringes the formed depression. If the sunken part has a diameter of 2.5-3 cm, is regarded as a sharply positive (+++), and the androgenic function is reduced approximately 3-fold; up to 1 5 cm - positive (++) - function decreased 1.5-2 times - if less - the initial symptom of "sickle" (+) - a decrease in the reserve androgen function is observed.

[1], [2], [3], [4], [5]